Your life is going well. You have a great husband and marriage, furkids who bring you great joy, a loving family, wonderful friends, a job you love with people who are awesome, a career which is mentally and emotionally fulfilling, and volunteer work which keeps your heart full. Your life is active, busy and you love it.
You do what you’re supposed to do, for the most part, to maintain your health. You get an annual mammogram, and you are asked to return for more views. It’s okay, the same thing happened last year and everything was fine. It’s that darn dense breast tissue that causes problems. So you go back for more views. More views are taken, the radiologist views them. You’re told that an ultrasound is needed. The ultrasound is done, the technician tells you the radiologist wants to talk to you.
She tells you that a lump was found on your right breast which wasn’t there last year. It’s irregular in shape, she says, and suggests a needle biopsy. She can do it right now, if you like. You opt to have it done, and then wait for the results.
Five days later, you get the call. It’s cancer.
Since that call, my life has been turned upside down. It’s been a whirlwind of appointments, tests, examinations, and decisions to be made. It’s also been a time of even more tests, more waiting for results so more decisions can be made. Here’s what I know.
The lump is 1.93 cm at its largest. The cancer is invasive ductal carcinoma, which means the cancer is not contained in the milk duct, but has started to “leak out.” The grade, or the “score” which indicates how different the cancer cells’ appearance and growth patterns are from those of normal, healthy, breast cells, is a 2+ (out of 3). This means the cells are moderately differentiated; they do not look like normal cells and are growing and dividing a little faster than normal. It’s an indicator that the prognosis is intermediate.
Breast cancer treatment is designed for the long view – focused on minimizing recurrence. It starts with surgery to remove the tumor and the sentinel lymph node. These will be examined to find out more definitively about my cancer. How far has it spread? Can the surgeon get clear margins after removal of the tumor? Once the final pathology is done on the tumor and lymph node(s), then the cancer is given a stage.
After surgery, the treatment to reduce the chance of recurrence starts.
My cancer is estrogen and progesterone receptor negative. Some cancers are fueled by the hormones estrogen and progesterone, and if so, can be treated with hormone therapy. One could say that being negative in this case isn’t good, because it means that I will need chemotherapy rather than hormone therapy. On the other hand, hormone therapy continues for five years, so I’m choosing to think of this as a positive.
HER2 (human epidermal growth factor 2) is a protein; some breast cancers (1 in 4) make too much of this protein and therefore have too many HER2 receptors at the cell surface. With too many receptors, the cancer cells grow too much too fast. One treatment (Herceptin) is to block the receptors so the cells don’t pick up the growth signals. My cancer is HER2 positive. While a HER2 positive cancer is aggressive, my medical oncologist (Dr. Priya) assures me that chemotherapy is especially effective on rapidly dividing cells.
What’s next? Because I have dense breast tissue, and because not everything can be seen via mammography and/or ultrasound, I’m having a breast MRI on Monday (12/22/14). I’m also having a biopsy done on my left breast on Christmas Eve; upon exam, my surgeon (Dr. Ching) found what she believes to be a benign fatty tumor on the left breast, but she wants to be absolutely sure. Then I have a consult with a plastic surgeon to discuss reconstruction options, which are done right after Dr. Ching removes the tumor and lymph node(s). Surgery will be scheduled; recovery will take 4-6 weeks. Chemotherapy starts after recovery; I’ll have 2 types. The regimen to address my hormone receptor negative status is an infusion once every 3 weeks for 4 cycles (12 weeks); Herceptin can start as the same time as the other chemo, but that’s once a week for 52 weeks. Yep, 52 weeks. An entire year. And then sometime I’ll have radiation.
I’ve told my family, and of course they’re very supportive. My sister and niece have come with me to my appointments – breast cancer educator, breast surgeon, medical oncologist – and I’ve started to tell friends. I’ll wait to tell my staff until I know the date of my surgery, but it seems likely that I’ll be home recovering from surgery for 3-4 weeks. It could be that the surgery is more extensive, depending on what the MRI shows, on what the left breast biopsy shows, on what the surgeon finds when she excises the tumor. If you’re uncomfortable with uncertainty, this is not a good time.
[This blog post is the “front page” – all other posts are in reverse chronological order, so if this is your first time here, scroll to the bottom and read up.]